Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices
Abstract
:1. Introduction
1.1. Marginalized Groups with Higher Risks for Sex Trafficking
1.2. Prevalence and Its Challenges
1.3. Points of Entry—Opportunities for Intervention
1.4. Gaps in the Literature
1.5. Significance of this Research
1.6. Theory and Framework
2. Methods
2.1. Sampling of Participants
2.2. Geographic Regions of the Study—San Diego, CA, and Philadelphia, PA
2.3. Safeguards for Identity Protection
2.4. Eligibility Criteria
2.5. Data Collection
2.6. Data Analysis
3. Results
3.1. Sociodemographic Characteristics
3.2. Potential Red Flags among ST-Patients
3.2.1. Physical Injuries, Medical Records, and Other Comorbidities
She [HCP] went back on my medical records and she was like ‘you’ve been here for a broken arm. You have been here for a lot of stuff…’ I had told them that I was hit by a car, but I really had been thrown out of the car. [In another occasion] he [trafficker] broke my arm. That was different. When hit me in the head with the pole, I [also] went to the [same] hospital. She pulled all my medical records! So she was like ‘you sure have a lot of accidents’ (sarcastic tone). I was like, ‘well, I am clumsy’.
The provider should really look at the medical records. Always look at the medical records period. If it’s something similar every time, that’s a Red Flag. They [HCPs] could say like, ‘why is this always happening?’ [But] make a joke out of it. Like, ‘oh you seem to be like a punching bag’ or something like that. It is not funny [of course], but it is more like an icebreaker. They [the patient-victim] may follow back with something funny like, ‘Yah, just every few weeks’. Something like that, depending on the way it is answered, could be [a Red Flag].
I got triaged when I was in the back, talking to the doctor. They gave me medicine to numb my [broken] jaw [injury resulting from her trafficker’s physical assault]. They did X-rays and stuff. He [trafficker] went back there [trafficker tracked Ann down through phone’s GPS and showed up at the hospital pretending to be the boyfriend]. Yeah, once the nurse left, he grabbed my arm, pulled the IV out, and said, ‘Let’s go!’ Then, he beat me up more when I went back to the hotel room because I went to the hospital without waiting on him.
Yeah, they [HCPs] asked me what happened, and I told them that I fell out the car. And that the car was driving and that I pulled too hard on the door and that I fell out the car.
Other comorbidities included drug dependency and mental health issues.She was called the mistress [trafficker’s assistant], and she was like basically like the rule enforcer. And, if you didn’t listen, then you went to her farm. And, she did not do so nice stuff to you. You were starved and put on a chain; treated like an animal.
3.2.2. Sexual Risk Behavior, Repetitive STI Screenings, and Reproductive Care
Well, we would go every 3–6 months. He wouldn’t bring us all at the same time. …I got birth control. So I wouldn’t get pregnant. I had my abortions there… One time, when I went in for a STD check and it came back [positive]. He [trafficker] lost it, kind of, in the office because [the test was positive]. He was, ‘well you did it without protection. What the hell?!’ I never did anything without protection unless it was with him. But he just freaked out but got the medicine for me to get rid of it.
Probably the multiple sexual partners. I mean. That was really the only thing that I had brought to their [HCP] attention.
Frequent visitations. …You must get tested. You must do this. But because of the number of partners I had, they would tell me, ‘We are not going to give you another pap smear. You just had one’. You know? And I was like, ‘Let me get tested!’ You know? So I think frequent visitations is a good sign [of victimization].
A lot of times, in the mental illness section [of the medical intake form], we disclose information to them [HCPs] in hopes of getting help for what we’re dealing with. So, obviously, you know if there’s abuse; if they speak about abuse going on; if they speak about multiple partners; if they speak about rape… I think those are Red Flags.
- I: What kind of questions would they [HCP] ask you?
- P: ‘How many partners have you been with? Do you use protection all of the time?’
- I: Would you answer those questions honestly?
- P: We wouldn’t give the honest answers. ‘Have you been with more than ten people in the last 6 months?’ No, ‘I have only been with one’. I wouldn’t, or some of the other girls would be like, ‘Yeah, we sleep with this many people’. One time, one of the girls told the [HCPs] how many. The [patient-victim] was like, ‘Oh, I was just joking’.
- I: Did they say something to her?
- P: They were like, ‘Oh, that’s a funny joke’. …That’s weird. Why would you joke about that?
3.2.3. Accompanying Person’s Control of Medical Care and Services
So, I mean, he [trafficker] would come and go [to visit Redd at the hospital]. But every time he would come, he would be like, ‘remember, don’t say nothing, Daddy loves you and am sorry! OK?!’ …And then, they [healthcare providers] even apologized to him. They’re like, ‘we are so sorry that we even assumed that you would hit your girlfriend’. Because when the nurse questioned him about my injuries, he said, ‘let me speak to your supervisor. Let me speak to the person in charge! You guys are trying to accuse me of hitting on my girlfriend. I love her!’He started crying. He was like, ‘I would never hit her!’ I was just like, ‘dammed you are a good actor (laughs)’. And then, they [nurses] called main [hospital] management and they talked to him. And he was like, ‘I just don’t feel that just because my girlfriend has a lot of accidents, I don’t feel that’s my fault she is clumsy… blah, blah, blah’. So they (hospital staff) felt stupid. He made them feel dumb.
Yeah, he would tell me like, ‘Don’t tell them anything about what you are doing. Just tell them that you are living with me. I’m your boyfriend… Just say that you got jumped and attacked, and you didn’t see the person’s face or anything.
It can be very packed in those hospitals [Emergency Department]. He would choose what hospital I went to depending on how many people were waiting. There were times when we went to two or three different hospitals because it would be so busy. Like, if there were so many people in the waiting room, then he would go to the other one, so he didn’t have to wait as long.
Like, he did most of the talking, but they would ask me questions um about like… You know like, “On a 1 to 5, how are you feeling?” Type of stuff. Exactly, where does it hurt? Or, what kind of pain are you feeling? They asked me what happened. I kind of give them a gist. Then, he would explain it more. Or there were times when he didn’t want me to go to the hospital. He wouldn’t let me go. He kind of told me to suck it up. He was mad because a John robbed me that time.
3.2.4. Body Modifications
I think a lot of times, when we think about human trafficking in America, we think about Asians or Indians. Or a lot of times, we don’t think about Americans. So, it’s kind of hard because the appearances… you know… [For example] when I was in the Valley, there are a lot of people of upper-class and a lot of escorts and call-girls who are being trafficked. And, you know… they are gorgeous! They look like they got it all together, and no one knows what’s going on.
If somebody is coming in there with like tattoos, and I am not saying that everybody who has tattoos is human trafficking victim, but come’n now [shows interviewer her tattoos—money sign in her forearm and points to her side of her face where she has another one], like ‘give money’ ‘money bags’ ‘dollar signs all over my body’ a dollar sign on my face… somebody’s name tattooed on my face… It’s only common sense!
3.2.5. Other Signs and Caution
3.3. Supportive Healthcare Practices when Caring for Patient-Victims of Sex Trafficking
3.3.1. Do Not Ignore Potential Signs
So, the Planned Parenthood visits were for periodic checks for STDs basically. And, when I went in there, one of the questions they would ask me was, ‘How many sex partners have you had in the past 30 days?’ And, I would always say, ‘I don’t know, maybe 50?’ And then, they didn’t make any comment about it at all, and then, I’d say, ‘Oh, yeah. I’m an escort’. And, they wouldn’t say anything about it, and I thought, ‘This is such bullshit’. And then, they just basically handed me, you know, they always handed me condoms. They would literally hand me like hundreds of them.
When I went in to get testing [STI], even though you fill out some paperwork, I think one of the first questions on there was, “Do you know about how many partners have you been with the last 30 days?” You know? I could never recall. So I would always say, “a few hundred” or “very many”, something like that. I’m pretty sure that they had an idea, but I don’t think they knew about how to talk about it, you know what I mean? They never said anything after I would share how many partners I had.
3.3.2. Feeling Comfortable and Safe
First and foremost, it was an extremely secure location. They were [also] extremely hospitable there. If you were hungry, they would feed you. …, they had like little … sandwiches or chips or whatever, [they would] feed you. They were super hospitable. The therapist who talked to me would bring up a concern and ask me if I needed help. They would give me several resources. They were great [laughs]. So, I felt safe being in the facilities because I knew that everyone was searched. In the waiting room, they had televisions there too. When you go and you tell them you’re there for an appointment or you’d like to see so and so, they would often ask if you’d eaten. And, I don’t know if they did it just to me because I looked homeless or what. They would ask me if I’d eaten. …Stuff like that, you know? They were really friendly. I don’t know. They were nice. I felt it was. I enjoyed going there.
3.3.3. Asking Questions Respectfully
My recommendation would be to ask questions very carefully. Many [patient-victim] may not be comfortable with talking about their situation. Try to be more careful. Try to be more caring, you know? Give them more information on where they can get help… The doctor that I was talking to asked me, ‘Well, why are you in this situation? Why are you on the streets?’ …Some people see prostitution like it’s disgusting to them. So, they could ask the question more like ‘what happened in your life that led you to this situation?’ They [HCP] could ask questions in a different way, you know? Making sure they [HCP] don’t ask them in a way that they wouldn’t want to be questioned, you know?
3.3.4. Caring about the Well-Being of the Patient-Victim
First and foremost, I’ll let them know [healthcare providers] to develop a compassionate view on the patient. To not be so judgmental and quick to judge based off a certain situation. [Also] to be willing to reach out and give that person help. The help and care that that person needs. To just be patient with the victim. You know. Ask questions. And, just to reassure [with emphasis] the victim that everything is okay.
Just kind of like make the person [patient-victim] feel like you are very compassionate and very concerned about her health.
I never had anybody (in the healthcare setting) say to me, ‘this is a great resource for you’ or ‘you should talk to somebody’, or ‘if you need help, these are some people who can help you’. Something so simple. It doesn’t have to be, you know, ‘I want to hear your whole story’. It can be something subtle and simple. And to just let her know that someone cares. Someone’s thinking about her. When people said to me (on the streets), ‘I’m going to pray for you’, that was enough for me because you are in the grip of survival. And for you to hear someone say that to you, even if you don’t know the person, shows that they care. Yet, nobody took the initiative to actually really care for me [in the healthcare setting].
3.3.5. Understand Assumptions or Perceptions of Victimization
A lot of people who don’t really have any experience with it [sex trafficking] and they kind of buy into the idea of the bad girl attitude—’Oh, she’s just a bad girl. She just got herself mixed up in something. Or, she’s making her choice. She’s made her bed, and now, she has to lie in it. These are her choices that she’s making’. And so, they put the responsibility on the woman. Then, they kind of leave it up to you [the patient-victim] to ask for help. Whether they are not aware or ignorant, they have wrong perceptions about it… After I went to Planned Parenthood and I shared what I was doing, they didn’t even blink, you know? I kind of got belligerent with the medical community. Just seeing like, ‘They didn’t give a shit’. They didn’t ask if I needed anything, nothing.
3.4. Resources and Information for Patient-Victims of Sex Trafficking
3.4.1. Information—Displayed or Hidden
You know how they have posters in the [examining] room? Have like a poster that you can look at [while you are waiting for the doctor to come in]. Not where you have to actually pick up a paper and bring it with you, but something that you can see and remember a number. You know how they have the baby’ progressing along [while they mother is pregnant]? A poster like that would be useful.
Yeah, I think I’m extremely resourceful. So, yeah, when I’m waiting, I do a lot of reading. So, having the resources on display is extremely helpful because then, in confidentiality, I can decide whether or not if I want to utilize the information.
For healthcare providers to share what is available to victims such as [name of local organizations], If the person [patient] is stand-offish, they [healthcare provider] can just say, ‘Well, I just have some information if you might be interested, and you can find it here’. Or, they give us condoms. They can have the info right inside the condoms. You know? When we leave, they [healthcare providers] give us like 20 condoms.… They can just slide it in, and you know those have numbers to inform us of what’s out there.
3.4.2. Other Type of Resources
Organizing educational trainings for the nurses or the head of the ER, such workshops and panels where they get together, learn and listen to what people [survivors] have to say and experts like [named director of her previous program].
Um, having a code word and all that. Also having a specific list of people that can call and show up at the hospital. And if you aren’t on that list, unless you know that code word, you aren’t getting in. You just can’t. …To me the most important thing is safety. [However], you have to be trained to know the process, already have that in place because if you do it on the whim, it’s not going to work. You got to have some type of plan [and be ready for different situations]. Yeah, just in case because you never know what…can happen at any time. She can have just jumped out of the car and ran into the hospital trying to get away from him. And he might be hunting her down, but as long as there is a plan in place, it can work.
Some girls might be ready and might not know they’re ready. For instance, like they might just don’t want to be in the situation, but they feel like that’s it. That’s life. So, you just want to, kind of probe them and figure out what they do in life. If you find out that’s what she’s doing and she specifically tells you, tell her like, ‘Look, if you don’t want to be in that lifestyle and you want to get some help, we can help you. Probably find you a bed some place, and they can help you eventually find an apartment and get a job. All that stuff’.
4. Discussion
4.1. Future Recommendations
4.2. Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Socio-Demographic Characteristics | N = 22 (%) |
---|---|
Age | |
Mean | 30 |
Race | |
White | 11 (50.00) |
Black | 5 (22.72) |
Biracial | 3 (13.63) |
Latina | 3 (13.63) |
Marital Status | |
Single | 15 (68.18) |
Divorced | 4 (18.18) |
Married | 1 (4.54) |
Living with unmarried partner | 1 (4.54) |
Separated | 1 (4.54) |
Years of Sex Trafficking Victimization * | |
Mean | 4.7 |
Healthcare Settings Visited During Victimization | |
Emergency Departments | 17 (77.27) |
Community Care Clinics (Planned Parenthood) | 16 (72.72) |
Urgent Care | 7 (31.81) |
Mental Health | 5 (22.72) |
Geographic Location | |
San Diego, California (CA) | 18 (81.81) |
Philadelphia, Pennsylvania (PA) | 4 (18.18) |
Potential Red Flags Among ST-Patients | |
Physical Injuries, Medical Records, and Other Comorbidities | The provider should really look at the medical records… If it’s something similar every time, that’s a Red Flag. |
Sexual Risk Behavior, Repetitive STIs Screenings, and Reproductive Care | Probably the multiple sexual partners. I mean. That was really the only thing that I had brought to their [HCP] attention. |
Accompanying Person’s Control of Medical Care and Services | Like, he did most of the talking, but they would ask me questions um about like… You know like, “On a 1 to 5, how are you feeling?” Type of stuff. |
Body Modifications | If somebody is coming in there with like tattoos… [shows interviewer her tattoos—money sign in her forearm and points to her side of her face where she has another one], … somebody’s name tattooed on my face… |
Supportive Healthcare Practices when Caring for Patient-Victims of Sex Trafficking | |
Do Not Ignore Potential Signs | …Planned Parenthood… one of the questions they would ask me was, ‘How many sex partners have you had in the past 30 days?’ … I don’t know, maybe 50?’ … I’d say, ‘Oh, yeah. I’m an escort’. |
Feeling Comfortable and Safe | [I]t was an extremely secure location… They were super hospitable. The therapist who talked to me would bring up a concern and ask me if I needed help. They would give me several resources. … So, I felt safe being in the facilities because I knew that everyone was searched… |
Asking Questions with a Caring Approach | My recommendation would be to ask questions very carefully… Many may not be comfortable with talking about their situation… Try to be more caring, you know? Give them more information on where they can get help… |
Compassionate Care—Reaching Out and Caring | I’ll let them know [healthcare providers] to develop a compassionate view on the patient. To not be so judgmental and quick to judge based off a certain situation. [Also] to be willing to reach out and give that person help… To just be patient with the victim. You know. Ask questions… reassure the victim that everything is okay. |
Understand Assumptions or Perceptions of Victimization | After I went to Planned Parenthood and I shared what I was doing, they didn’t even blink, you know? I kind of got belligerent with the medical community. Just seeing like, ‘They didn’t give a shit’. They didn’t ask if I needed anything, nothing. |
Shared Information with Patient-Victims of Sex Trafficking at the Healthcare Setting | |
Information—Displayed or Hidden | Have like a poster that you can look at, while you are waiting for the doctor to come in… something that you can see and remember—a number. You know how they have the baby’ progressing along while the mother is pregnant? |
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Richie-Zavaleta, A.C.; Villanueva, A.M.; Homicile, L.M.; Urada, L.A. Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices. Sexes 2021, 2, 26-49. https://doi.org/10.3390/sexes2010003
Richie-Zavaleta AC, Villanueva AM, Homicile LM, Urada LA. Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices. Sexes. 2021; 2(1):26-49. https://doi.org/10.3390/sexes2010003
Chicago/Turabian StyleRichie-Zavaleta, Arduizur C., Augusta M. Villanueva, Lauren M. Homicile, and Lianne A. Urada. 2021. "Compassionate Care—Going the Extra Mile: Sex Trafficking Survivors’ Recommendations for Healthcare Best Practices" Sexes 2, no. 1: 26-49. https://doi.org/10.3390/sexes2010003